Anti-PD-L1 Treatment Induced Central Diabetes Insipidus.

MedStar author(s):
Citation: Journal of Clinical Endocrinology & Metabolism. 103(2):365-369, 2018 02 01.PMID: 29220526Institution: MedStar Washington Hospital CenterDepartment: Medicine/Internal MedcineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Antibodies, Monoclonal/tu [Therapeutic Use] | *B7-H1 Antigen/im [Immunology] | *Diabetes Insipidus, Neurogenic/dt [Drug Therapy] | Aged | B7-H1 Antigen/ai [Antagonists & Inhibitors] | Humans | Immunotherapy/mt [Methods] | Male | Remission InductionYear: 2018Local holdings: Available online through MWHC library: 1999- June 2013, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0021-972X
Name of journal: The Journal of clinical endocrinology and metabolismAbstract: Case Description: We describe a case of a 73-year-old man with Merkel Cell Carcinoma (MCC) who received the anti-PD-L1 monoclonal antibody avelumab, and achieved partial response. The patient developed nocturia, polydipsia, and polyuria three months after starting avelumab. Further laboratory testing revealed central diabetes insipidus (DI). Avelumab was held and he received desmopressin for the management of central DI. Within six weeks after discontinuation of avelumab, the patient's symptoms resolved and he was eventually taken off desmopressin. The patient remained off avelumab, and there were no signs or symptoms of DI two months after the discontinuation of desmopressin.Conclusion: To our knowledge, this is the first report of central DI associated with anti-PD-L1 immunotherapy. The patient's endocrinopathy was successfully managed by holding treatment with the immune checkpoint inhibitor. This case highlights the importance of early screening and appropriate management of hormonal irAEs in subjects undergoing treatment with immune checkpoint inhibitors to minimize morbidity and mortality.Context: Immune checkpoint inhibitors, including anti-PD-1, anti-PD-L1 and anti-CTLA4 monoclonal antibodies, have been widely used in cancer treatment. They are known to cause immune-related adverse events (irAEs), which resemble autoimmune diseases. Anterior pituitary hypophysitis with secondary hypopituitarism is a frequently reported irAE, especially in patients receiving anti-CTLA4 treatment. In contrast, posterior pituitary involvement, such as central diabetes insipidus (DI), is relatively rare and is unreported in patients undergoing PD-1/PD-L1 blockade.All authors: Brownell I, Del Rivero J, Ebenuwa I, Gulley J, Kommalapati A, Strauss J, Tella SH, Zhao CFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-12-20
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29220526 Available 29220526

Available online through MWHC library: 1999- June 2013, Available in print through MWHC library: 1999 - 2006

Case Description: We describe a case of a 73-year-old man with Merkel Cell Carcinoma (MCC) who received the anti-PD-L1 monoclonal antibody avelumab, and achieved partial response. The patient developed nocturia, polydipsia, and polyuria three months after starting avelumab. Further laboratory testing revealed central diabetes insipidus (DI). Avelumab was held and he received desmopressin for the management of central DI. Within six weeks after discontinuation of avelumab, the patient's symptoms resolved and he was eventually taken off desmopressin. The patient remained off avelumab, and there were no signs or symptoms of DI two months after the discontinuation of desmopressin.

Conclusion: To our knowledge, this is the first report of central DI associated with anti-PD-L1 immunotherapy. The patient's endocrinopathy was successfully managed by holding treatment with the immune checkpoint inhibitor. This case highlights the importance of early screening and appropriate management of hormonal irAEs in subjects undergoing treatment with immune checkpoint inhibitors to minimize morbidity and mortality.

Context: Immune checkpoint inhibitors, including anti-PD-1, anti-PD-L1 and anti-CTLA4 monoclonal antibodies, have been widely used in cancer treatment. They are known to cause immune-related adverse events (irAEs), which resemble autoimmune diseases. Anterior pituitary hypophysitis with secondary hypopituitarism is a frequently reported irAE, especially in patients receiving anti-CTLA4 treatment. In contrast, posterior pituitary involvement, such as central diabetes insipidus (DI), is relatively rare and is unreported in patients undergoing PD-1/PD-L1 blockade.

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